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Sandplay with Children

Kay Bradway

Kay Bradway, Ph.D., JA, is a founding member of Sandplay Therapists of America and the
International Society for Sandplay Therapy. She is a psychologist and Jungian analyst in Sausalito,
California.

Sandplay has an accelerating history. It goes back to an early decade of this century when H.G. Wells
wrote about his observing his two sons playing on the floor with miniature figures and his realizing
that they were working out their problems with each other and with other members of the family.
Twenty years later Margaret Lowenfeld, child psychiatrist in London, was looking for a method to
help children express the "inexpressible." She recalled reading about Wells' experience with his two
sons and so she added miniatures to the shelves of the play room of her clinic. The first child to see
them took them to the sandbox in the room and started to play with them in the sand. And thus it
was a child who "invented" what Lowenfeld came to identify as the World Technique (Lowenfeld,
1979).

When Dora Kalff, Jungian Analyst in Zurich, heard about the work in England, she went to London to
study with Lowenfeld. She soon recognized that the technique not only allowed for the expression of
the fears and angers of children, but also encouraged and provided for the processes of
transcendence and individuation she had been studying with C.G. Jung. As she developed the
method further, she gave it the name "sandplay" (Kalff, 1980). Jungian analysts from five countries
joined Kalff in founding the International Society for Sandplay Therapy in 1985. The American
affiliate society, Sandplay Therapists of America, was founded in 1988. The first issue of the Journal
of Sandplay Therapy appeared in 1991.

The essentials of sandplay therapy are a specially proportioned sandtray, a source of water, shelves
of miniatures of multitude variety: people, animals, buildings, bridges, vehicles, furniture, food,
plants, rocks, shells-the list goes on-and an empathic therapist who provides the freedom and the
protection that encourages children (or adults) to experience their inner, often unrealized, selves in
a safe and non-judgmental space. The therapist as a witness is an essential part of the method, but
this therapist is in the mode of "appreciating", not "judging", what the sandplayer does. It is
necessary that the therapist follows the play and stays in tune with it, but not intrude. The therapist
follows the child.

Given an empathic therapist, children rarely need any encouragement to start making pictures or
scenes and playing in the sand. They come to it naturally. They may engage the therapist in the play
but unlike some therapies there is no attempt on the part of the therapist to interpret to the child
what the therapist may understand of what is going on in the sandplay. The process of touching the
sand, adding water, making the scenes, changing the scenes, seems to elicit the twin urges of healing
and transformation which are goals of therapy. This does not mean that the therapist remains
distant or unresponsive. But the emphasis is on following the child rather than on imposing a
structure on the play or even guiding the play. The child's psyche becomes the guide rather than the
therapist.

The child may need to engage the therapist in the play. I recall a little ten-year old girl whom I call
Kathy who came to therapy with problems of fears of failure and of her anger that had built up over
the years. She was fearful of expressing her anger and typically placed fences in the tray after having
expressed anger toward or about any member of the family. We did not have to talk about this. By
placing the fences around jungle animals, she was able to experience an ability to do something
about controlling these animals and, in extension, about her anger and then to feel safer to sense
and express her own aggressive feelings. At first this did not include me, but eventually she
translated her sandplay into an interaction with me. She came to a point where she alternated
between having us "fight" with toy cannons in the sand tray and playing out positive feelings
towards me. But there was no need to interpret the transference. Kathy worked it out herself. She
had us build a sand castle together in the final tray (Bradway and McCoard, 1997).

The tray provided for Kathy, as it does for other children, the place to work through many phases of
self-healing and growing up. For example, a child's placing water and food for animals in the tray is
often a step in learning how to obtain nourishment on their own rather than having to depend on its
being offered by others and thus provides a step towards a higher level of ego autonomy. Sources of
energy other than food, such as wells, gasoline pumps, windmills, often appear during periods of
transition when the ego needs an additional supply of energy in order to cope with a struggle
between inner and outer forces. And most significantly, the tray provides for the experiencing of
wholeness.

References:
Bradway, K. and McCoard, B. (1997). Sandplay-Silent workshop of the psyche. London/New York:
Routledge.
Kalff, D. (1980). Sandplay, a psychotherapeutic approach to the psyche. Santa Monica: Sigo.
Lowenfeld, M. (1979). The world technique. London: Allen & Unwin.

Journal of Sandplay Therapy, Volume 8, Number 2, 1999.
What is Sandplay Therapy?

Lauren Cunningham

Lauren Cunningham, LCSW, is a founding member of Sandplay Therapists of America and the
founding editor of the Journal of Sandplay Therapy.

Children have always delighted in playing in the sand, bringing their inner and outer worlds together
through imagination. Different cultures have also used sand in imaginal rituals of visioning. The
Dogon medicine men of Mali draw patterns in the sand and later read the paw prints left in the night
by the desert fox to divine the future. Tibetan Buddhist monks spend weeks creating the Kalachakra
sand mandala, which is used for contemplation and initiation into Tantric practices. Donald Sandner,
in Navaho Symbols of Healing, wrote about the Navaho sand painting ceremonies in which images of
world order are created to invoke the healing powers that bring the psyche of the people back into
harmony with the universe. Upon the completion of all these rituals the sand is brushed away and
dispersed.

Whether the makers of these sand creations are children, healers, or priests, potent and ineffable
energies can be stirred on an intuitive, non-rational level. Sand opens the door to the unconscious
world. In western European folklore, the sandman puts children to sleep by sprinkling sand into their
eyes. Sand is impressionable, mutable, and impermanent: "Dancing on sands, and yet no footing
seen," Shakespeare wrote in Venus and Adonis. The sand particles, created by the disintegration of
the earth's rocks, are ideal for pouring and shaping into an image of the symbolic world. We can
"...see a World in a grain of Sand" as Blake wrote in Auguries to Innocence.

So it's not surprising that psychotherapists as contemporary healers stumbled upon playing in the
sand as a therapeutic method. Margaret Lowenfeld, a pioneering child psychoanalyst during the
30's, was the first therapist to put sand into trays with water and figures nearby in her consulting
room. She graciously attributed the invention of what she later called the "World Technique" to the
children themselves who naturally brought these materials together in play therapy.

Dora Kalff was initially influenced by Emma and Carl Jung and her immersion in Tibetan Buddhism.
She also studied with Lowenfeld in London for a year in 1956. When she returned to Zrich Kalff
developed another way of using these materials therapeutically which she called "sandplay."

Sandplay therapists who work in the way Kalff taught differentiate sandplay from sandtray therapy.
Sandtray therapy is a more generic term referring to a variety of effective ways of using sand,
figures, and a container from different theoretical perspectives. Sandplay therapy emphasizes the
spontaneous and dynamic qualities of the creative experience itself. The essence of sandplay is non-
verbal and symbolic. In what Kalff called the "free and protected place" provided by the tray and the
relationship with the therapist, children and adults play with sand, water, and miniatures over a
period of time, constructing concrete manifestations of their inner world. When energies in the form
of "living symbols" are touched upon in the personal and collective unconscious, healing can happen
spontaneously within a person at an unconscious level. As a more harmonious relationship between
the conscious and the unconscious develops, the ego is restructured and strengthened.

Sandplay may open the person to re-experience pre-verbal and non-verbal states. Children
understand (recognize) language before they can speak (recall) language. An adult may have
forgotten or never learned words for some inner experience. Yet they may recognize a figure
intuitively without being able to recall why or what it is. That's why sandplay therapists sometimes
say, "Let the figure pick you!"

The quiet tray with its smooth sand and a trusted therapist nearby allows images to arrive for the
maker. The variety of figures and the sensory experience of sand and water also stimulate the
unconscious. The elemental nature of sandplay evokes the body and touches the mother within.
Sand can be molded, water poured, fire ignited, and air blown. The elemental flow and balance that
is created in the tray mirrors processes in the psyche as well as in the natural world.

The size of the tray itself is meant to hold a person's steady gaze which may encourage a
concentration and intensification of the psyche's energies. The sand and blue bottom and sides offer
the concrete possibility of digging down to the depths or building up to the heights. The three
dimensional figures also offer a fullness of representation that requires no skill. Even a three year old
can build complex, multidimensional scenes. These figures can facilitate both differentiating and
linking together different pieces of meaning and bringing them further into consciousness. Like the
alchemical vessel, the tray within the relationship between the person and the therapist contains
and intensifies the heat and pressure so that a change can happen.

Sandplay's efficacy comes from creating the sand picture itself, as a form of active imagination, not
in focusing on cognitive processing or on the completed production. Sandplay pictures are generally
not interpreted while a process is going on so that the maker can stay close to the living experience
in their body and imagination. The therapist is a witness who primarily reverberates empathically to
the person playing in the sand. When both simultaneously experience the inner world of the
sandplayer through the medium of sandplay a synchronistic moment happens. This helps both to
contain and to honor the experience so that it continues on working in the person. Sandplay is
usually done adjunctively to talk therapy which carries the interpretive aspects of the
psychotherapeutic work. Review and more analytic discussion of the trays themselves can happen
years after the process is completed. The heart of becoming a sandplay therapist is in the
experiencing of a personal sandplay process with its cycles of getting lost, waiting, and coming
home. It is a deeply held Jungian principle that the therapist as wounded healer has to have been
initiated themselves before becoming a guide for others.

Although the use of sand in ritual practices exists on a continuum from ancient traditions through
Jungian and other psychotherapeutic methods, sandplay therapists are now concerned about the
economics of healthcare and the impact of modern day values on the future of sandplay. Sandplay
therapists also need to continue to relate their work to ongoing developments in understanding the
psyche. In the midst of the thrust and rush towards the future, the simplicity and depth of sandplay
may help it maintain its integrity as a place of sanctuary and healing.


Reference:
Sandner, Donald (1991). Navaho Symbols of Healing. Rochester: Healing Arts Press.

Journal of Sandplay Therapy, Volume 6, Number 1, 1977.
Play therapy
From Wikipedia, the free encyclopedia
Play therapy
Intervention
ICD-9-CM 93.81, 94.36
MeSH D010989
Play therapy is generally employed with children aged 3 through 11 and provides a way for them to
express their experiences and feelings through a natural, self-guided, self-healing process. As
childrens experiences and knowledge are often communicated through play, it becomes an
important vehicle for them to know and accept themselves and others.
Contents [hide]
1 General
2 History
3 Growth of organizations
4 Models
4.1 Nondirective play therapy
4.1.1 Efficacy
4.2 Directive play therapy
4.2.1 Efficacy
5 Parent/child play therapy
6 See also
7 References
8 Bibliography
9 Further reading
10 External links
General[edit]

Play therapy is a form of counseling or psychotherapy that uses play to communicate with and help
people, especially children, to prevent or resolve psychosocial challenges. This is thought to help
them towards better social integration, growth and development.
Play therapy can also be used as a tool of diagnosis. A play therapist observes a client playing with
toys (play-houses, pets, dolls, etc.) to determine the cause of the disturbed behavior. The objects
and patterns of play, as well as the willingness to interact with the therapist, can be used to
understand the underlying rationale for behavior both inside and outside the session..
According to the psychodynamic view, people (especially children) will engage in play behavior in
order to work through their interior obfuscations and anxieties. In this way, play therapy can be used
as a self-help mechanism, as long as children are allowed time for "free play" or "unstructured play."
Normal play is an essential component of healthy child development.
One approach to treatment is for play therapists to use a type of desensitization or relearning
therapy to change disturbing behavior, either systematically or in less formal social settings. These
processes are normally used with children, but are also applied with other pre-verbal, non-verbal, or
verbally-impaired persons, such as slow-learners, or brain-injured or drug-affected persons.
History[edit]

Play has been recognized as important since the time of Plato (429-347 B.C.) who reportedly
observed, you can discover more about a person in an hour of play than in a year of conversation.
In the eighteenth century Rousseau (1762/1930), in his book Emile wrote about the importance of
observing play as a vehicle to learn about and understand children. Friedrich Frbel, in his book The
Education of Man (1903), emphasized the importance of symbolism in play. He observed, play is the
highest development in childhood, for it alone is the free expression of what is in the childs soul.
childrens play is not mere sport. It is full of meaning and import. (Frbel, 1903, p. 22) The first
documented case, describing the therapeutic use of play, was in 1909 when Sigmund Freud
published his work with Little Hans. Little Hans was a five-year-old child who was suffering from a
simple phobia. Freud saw him once briefly and recommended that his father take note of Hans play
to provide insights that might assist the child. The case of Little Hans was the first case in which a
childs difficulty was related to emotional factors.
Hermine Hug-Hellmuth (1921) formalized the play therapy process by providing children with play
materials to express themselves and emphasize the use of the play to analyze the child. In 1919,
Melanie Klein (1955) began to implement the technique of using play as a means of analyzing
children under the age of six. She believed that childs play was essentially the same as free
association used with adults, and that as such, it was provide access to the childs unconscious. Anna
Freud (1946, 1965) utilized play as a means to facilitate positive attachment to the therapist and gain
access to the childs inner life.
In the 1930s David Levy (1938) developed a technique he called release therapy. His technique
emphasized a structured approach. A child, who had experienced a specific stressful situation, would
be allowed to engage in free play. Subsequently, the therapist would introduce play materials
related to the stress-evoking situation allowing the child to reenact the traumatic event and release
the associated emotions.
In 1955, Gove Hambidge expanded on Levys work emphasizing a Structured Play Therapy model,
which was more direct in introducing situations. The format of the approach was to establish
rapport, recreate the stress-evoking situation, play out the situation and then free play to recover.
Jesse Taft (1933) and Frederick Allen (1934) developed an approach they entitled relationship
therapy. The primary emphasis is placed on the emotional relationship between the therapist and
the child. The focus is placed on the childs freedom and strength to choose.
Carl Rogers (1942) expanded the work of the relationship therapist and developed non-directive
therapy, later called client-centered therapy (Rogers, 1951). Virginia Axline (1950) expanded on her
mentor's concepts. In her article entitled Entering the childs world via play experiences Axline
summarized her concept of play therapy stating, A play experience is therapeutic because it
provides a secure relationship between the child and the adult, so that the child has the freedom
and room to state himself in his own terms, exactly as he is at that moment in his own way and in his
own time (Progressive Education, 27, p. 68).
In 1953 Clark Moustakas wrote his first book Children in Play Therapy. In 1956 he compiled
Publication of The Self, the result of the dialogues between Abraham Maslow, Carl Rogers, Clark
Moustakas and others, forging the Humanistic Psychology movement.
Filial therapy, developed by Bernard and Louise Guerney, was a new innovation in play therapy
during the 1960s. The filial approach emphasizes a structured training program for parents in which
they learn how to employ child-centered play sessions in the home. In the 1960s, with the advent of
school counselors, school-based play therapy began a major shift from the private sector. Counselor-
educators such as Alexander (1964); Landreth (1969, 1972); Muro (1968); Myrick and Holdin (1971);
Nelson (1966); and Waterland (1970) began to contribute significantly, especially in terms of using
play therapy as both an educational and preventive tool in dealing with childrens issues.
1973 Clark Moustakas continues his journey into play therapy and publishes his novel "The child's
discovery of himself". Clark Moustakas' work as being concerned with the kind of relationship
needed to make therapy a growth experience. His stages start with the child's feelings being
generally negative and as they are expressed, they become less intense, the end results tend to be
the emergence of more positive feelings and more balanced relationships. Today, his daughter Kerry
Moustakas continues his legacy as an author and president of The Michigan School of Professional
Psychology. 2004 Clark and Kerry Moustakas publish Loneliness, Creativity and Love: Awakening
Meanings in Life.
Growth of organizations[edit]

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In 1982, the Association for Play Therapy (APT) was established marking not only the desire to
promote the advancement of play therapy, but to acknowledge the extensive growth of play
therapy. Currently, the APT has almost 5,000 members in twenty-six countries (2006). Play therapy
training is provided, according to a survey conducted by the Center for Play Therapy at the
University of North Texas (2000), by 102 universities and colleges throughout the United States. The
APT provides certification in play therapy and play therapy supervision for clinicians. They also offer
a list of play therapists by local and training opportunities.
In 1985, the work of two key Canadians in the field of child psychology and play therapy, Mark
Barnes and Cynthia Taylor, resulted in the establishment of Certification Standards through the non-
profit Canadian child psychotherapy and play therapy association. A fledgling group of practising
Canadian child psychotherapists and play therapists worked on developing an organization to meet
professional needs. It gradually expanded and eventually a Board of Directors was formed; objects
and by-laws were designed, revised, re-revised and finally approved by the Government of Canada.
The Canadian association was eventually recognized as a non-profit organization in 1986.
During 1995/1996, a whole new horizon opened up for the profession of play therapy as a result of
the Canadian Play Therapy Institute's pioneering efforts on an International basis. Play Therapy
International was founded from the Canadian Play Therapy Institute and there now existed a
mutually supportive recognition between Play Therapy International/The International Board of
Examiners of Certified Play Therapists, The Canadian Play Therapy Institute, as well as a number of
other professional bodies throughout the world.
In the UK, The United Kingdom Society for Play and Creative Arts Therapies Limited (known in short
as PTUK) was originally set up in October 2000 as Play Therapy UK with the encouragement of Play
Therapy International. Meanwhile the British Association of Play Therapists was distinguished from
its American counterpart in 1996 and was granted charity status within the UK in 2006 by the UK
Charities Commission.
By 2010 Play Therapy International has partnered sister organisations in Ireland, Canada, Australasia,
France, Spain, Wales, Malaysia, Romania, Russia, United Kingdom, Slovenia, Germany, New Zealand,
Hong Kong, Korea and Ethiopia.
Models[edit]



An individual engaging in sandplay therapy.


Equipment used for sandplay therapy.
Play therapy can be divided into two basic types: nondirective and directive. Nondirective play
therapy is a non-intrusive method in which children are encouraged to work toward their own
solutions to problems through play. It is typically classified as a psychodynamic therapy. In contrast,
directive play therapy is a method that includes more structure and guidance by the therapist as
children work through emotional and behavioral difficulties through play. It often contains a
behavioral component and the process includes more prompting by the therapist. Directive play
therapy is more likely to be classified as a type of cognitive behavioral therapy.[1] Both types of play
therapy have received at least some empirical support.[2] On average, play therapy treatment
groups when compared to control groups improve by .8 standard deviations.[2]
Nondirective play therapy[edit]
Nondirective play therapy, also called client-centered and unstructured play therapy, is guided by
the notion that if given the chance to speak and play freely under optimal therapeutic conditions,
troubled children and young people will be able to resolve their own problems and work toward
their own solutions. In other words, nondirective play therapy is regarded as non-intrusive.[3] The
hallmark of nondirective play therapy is that it has few boundary conditions and thus can be used at
any age.[4] This therapy originates from Carl Rogers's non-directive psychotherapy and in his
characterization of the optimal therapeutic conditions. Virginia Axline adapted Carl Rogers's theories
to child therapy in 1946 and is widely considered the founder of this therapy.[5] Different techniques
have since been established that fall under the realm of nondirective play therapy, including
traditional sandplay therapy, family therapy, and play therapy with the use of toys. Each of these
forms is covered briefly below.
Play therapy using a tray of sand and miniature figures is attributed to Margaret Lowenfeld, who
established her "World Technique" in 1929. Dora Kalff combined Lowenfeld's World Technique with
Jung's idea of the collective unconscious and received Lowenfeld's permission to name her version
of the work "sandplay" (Kalff, 1980).[full citation needed]
As in traditional nondirective play therapy, research has shown that allowing an individual to freely
play with the sand and accompanying objects in the contained space of the sandtray (22.5" x 28.5")
can facilitate a healing process as the unconscious expresses itself in the sand and influences the
sand player. When a client creates in the sandtray, little instruction is provided and the therapist
offers little or no talk during the process. This protocol emphasizes the importance of holding what
Kalff (1980) referred to as the "free and protected space" to allow the unconscious to express itself
in symbolic, non-verbal play. Upon completion of a tray, the client may or may not choose to talk
about his or her creation, and the therapist, without the use of directives and without touching the
sandtray, may offer supportive response that does not include interpretation. The rationale is that
the therapist trusts and respects the process by allowing the images in the tray to exert their
influence without interference.[citation needed]
Sand tray therapy can be used during family therapy. The limitations presented by the boundaries of
the sandtray can serve as physical and symbolic limitations to families in which boundary distinctions
are an issue. Also when a family works together on a sandtray, the therapist may make several
observations, such as unhealthy alliances, who works with who, which objects are selected to be
incorporated into the sandtray, and who chooses which objects. A therapist may assess these
choices and intervene in an effort to guide the formation of healthier relationships.[6]
Using toys in nondirective play therapy with children is another common method therapists employ,
a method which was derived from the creative toys used in Freud's theoretical orientations.[7] The
idea behind this method is that children will be better able to express their feelings toward
themselves and their environment through play with toys than through verbalization of their
feelings. Through these actions, then, children may be able to experience catharsis, gain more or
better insight into their consciousness, thoughts, and emotions, and test their own reality.[8]
Popular toys used during therapy are animals, dolls, hand puppets, crayons, and cars. Therapists
have deemed toys such as these more likely to encourage dramatic play or creative associations,
both of which are important in expression.[7]
Efficacy[edit]
Play therapy has been considered to be an established and popular mode of therapy for children for
over sixty years.[9] Critics of play therapy have questioned the effectiveness of the technique for use
with children and have suggested using other interventions with greater empirical support such as
cognitive behavioral therapy.[1] They also argue that therapists focus more on the institution of play
rather than the empirical literature when conducting therapy [10] Classically, Lebo argued against
the efficacy of play therapy in 1953, and Phillips reiterated his argument again in 1985. Both claimed
that play therapy lacks in several areas of hard research. Many studies included small sample sizes,
which limits the generalizeability, and many studies also only compared the effects of play therapy
to a control group. Without a comparison to other therapies, it is difficult to determine if play
therapy really is the most effective treatment.[11][12] Recent play therapy researchers have worked
to conduct more experimental studies with larger sample sizes, specific definitions and measures of
treatment, and more direct comparisons.[10]
Research is lacking on the overall effectiveness of using toys in nondirective play therapy. Dell Lebo
found that out of a sample of over 4,000 children, those who played with recommended toys vs.
non-recommended or no toys during nondirective play therapy were not more likely to verbally
express themselves to the therapist. Examples of recommended toys would be dolls or crayons,
while example of non-recommended toys would be marbles or a checker game.[7] There is also
ongoing controversy in choosing toys for use in nondirective play therapy, with choices being largely
made through intuition rather than through research.[8] However, other research shows that
following specific criteria when choosing toys in nondirective play therapy can make treatment more
efficacious. Criteria for a desirable treatment toy include a toy that facilitates contact with the child,
encourages catharsis, and lead to play that can be easily interpreted by a therapist.[8]
Several meta analyses have shown promising results toward the efficacy of nondirective play
therapy. Meta analysis by authors LeBlanc and Ritchie, 2001, found an effect size of 0.66 for
nondirective play therapy.[3] This finding is comparable to the effect size of 0.71 found for
psychotherapy used with children,[13] indicating that both nondirective play and non-play therapies
are almost equally effective in treating children with emotional difficulties. Meta analysis by authors
Ray, Bratton, Rhine and Jones, 2001, found an even larger effect size for nondirective play therapy,
with children performing at 0.93 standard deviations better than non-treatment groups.[1] These
results are stronger than previous meta-analytic results, which reported effect sizes of 0.71,[13]
0.71,[14] and 0.66.[3] Meta analysis by authors Bratton, Ray, Rhine, and Jones, 2005, also found a
large effect size of 0.92 for children being treated with nondirective play therapy.[2] Results from all
meta-analyses indicate that nondirective play therapy has been shown to be just as effective as
psychotherapy used with children and even generates higher effect sizes in some studies.[1][2]
There are several predictors that may also influence the effectiveness of play therapy with children.
Number of sessions is a significant predictor in post-test outcomes, with more sessions being
indicative of higher effect sizes.[1] Although positive effects can be seen with the average 16
sessions,[5] there is a peak effect when a child can complete 35-40 sessions.[3] An exception to this
finding is children undergoing play therapy in critical-incident settings, such as hospitals and
domestic violence shelters. Results from studies that looked at these children indicated a large
positive effect size after only 7 sessions, which provides the implication that children in crisis may
respond more readily to treatment [2] Parental involvement is also a significant predictor of positive
play therapy results. This involvement generally entails participation in each session with the
therapist and the child.[15] Parental involvement in play therapy sessions has also been shown to
diminish stress in the parent-child relationship when kids are exhibiting both internal and external
behavior problems.[16] Despite these predictors which have been shown to increase effect sizes,
play therapy has been shown to be equally effective across age, gender, and individual vs. group
settings.[1][2]
Directive play therapy[edit]
Directive play therapy is guided by the notion that using directives to guide the child through play
will cause a faster change than is generated by nondirective play therapy. The therapist plays a much
bigger role in directive play therapy. Therapists may use several techniques to engage the child, such
as engaging in play with the child themselves or suggesting new topics instead of letting the child
direct the conversation himself.[17] Stories read by directive therapists are more likely to have an
underlying purpose, and therapists are more likely to create interpretations of stories that children
tell. In directive therapy games are generally chosen for the child, and children are given themes and
character profiles when engaging in doll or puppet activities.[18] This therapy still leaves room for
free expression by the child, but it is more structured than nondirective play therapy. There are also
different established techniques that are used in directive play therapy, including directed sandtray
therapy and cognitive behavioral play therapy.[17]
Directed sandtray therapy is more commonly used with trauma victims and involves the "talk"
therapy to a much greater extent. Because trauma is often debilitating, directed sandplay therapy
works to create change in the present, without the lengthy healing process often required in
traditional sandplay therapy.[19] This is why the role of the therapist is important in this approach.
Therapists may ask clients questions about their sandtray, suggest them to change the sandtray, ask
them to elaborate on why they chose particular objects to put in the tray, and on rare occasions,
change the sandtray themselves. Use of directives by the therapist is very common. While traditional
sandplay therapy is thought to work best in helping clients access troubling memories, directed
sandtray therapy is used to help people manage their memories and the impact it has had on their
lives.[19]
Roger Phillips, in the early 1980s, was one of the first to suggest that combining aspects of cognitive
behavioral therapy with play interventions would be a good theory to investigate.[11] Cognitive
behavioral play therapy was then developed to be used with very young children between two and
six years of age. It incorporates aspects of Beck's cognitive therapy with play therapy because
children may not have the developed cognitive abilities necessary for participation in straight
cognitive therapy.[20] In this therapy, specific toys such as dolls and stuffed animals may be used to
model particular cognitive strategies, such as effective coping mechanisms and problem-solving
skills. Little emphasis is placed on the children's verbalizations in these interactions but rather on
their actions and their play.[18] Creating stories with the dolls and stuffed animals is a common
method used by cognitive behavioral play therapists in order to change children's maladaptive
thinking.
Efficacy[edit]
The efficacy of directive play therapy has been less established than that of nondirective play
therapy, yet the numbers still indicate that this mode of play therapy is also effective. In 2001 meta
analysis by authors Ray, Bratton, Rhine, and Jones, direct play therapy was found to have an effect
size of .73 compared to the .93 effect size that nondirective play therapy was found to have.[1]
Similarly in 2005 meta analysis by authors Bratton, Ray, Rhine, and Jones, directive therapy had an
effect size of 0.71, while nondirective play therapy had an effect size of 0.92.[2] Although the effect
sizes of directive therapy are statistically significantly lower than those of nondirective play therapy,
they are still comparable to the effect sizes for psychotherapy used with children, demonstrated by
Casey,[13] Weisz,[14] and LeBlanc.[3] A potential reason for the difference in the effect size may be
due to the amount of studies that have been done on nondirective vs. directive play therapy.
Approximately 73 studies in each meta analysis examined nondirective play therapy, while there
were only 12 studies that looked at directive play therapy. Once more research is done on directive
play therapy, there is potential that effect sizes between nondirective and directive play therapy will
be more comparable.[1][2]
Parent/child play therapy[edit]

Several approaches to play therapy have been developed for parents to use in the home with their
own children.[21]
Training in nondirective play for parents has been shown to significantly reduce mental health
problems in at-risk preschool children.[22] One of the first parent/child play therapy approaches
developed was Filial Therapy (in the 1960s - see History section above), in which parents are trained
to facilitate nondirective play therapy sessions with their own children. Filial therapy has been
shown to help children work through trauma and also resolve behavior problems.[23]
Another approach to play therapy that involves parents is Theraplay, which was developed in the
1970s. At first, trained therapists worked with children, but Theraplay later evolved into an approach
in which parents are trained to play with their children in specific ways at home. Theraplay is based
on the idea that parents can improve their childrens behavior and also help them overcome
emotional problems by engaging their children in forms of play that replicate the playful, attuned,
and empathic interactions of a parent with an infant. Studies have shown that Theraply is effective
in changing childrens behavior, especially for children suffering from attachment disorders.*24+
In the 1980s, Stanley Greenspan developed Floortime, a comprehensive, play-based approach for
parents and therapists to use with autistic children.[25] There is evidence for the success of this
program with children suffering from autistic spectrum disorders.[26][27]
Lawrence Cohen has created an approach called Playful Parenting, in which he encourages parents
to play with their children to help resolve emotional and behavioral issues. Parents are encouraged
to connect playfully with their children through silliness, laughter, and roughhousing.[28]
In 2006, Garry Landreth and Sue Bratton devleoped a highly researched and structured way of
teaching parents to engage in therapeutic play with their children. It is based on a supervised entry
level training in child centered play therapy. They named it Child Parent Relationship Therapy. [29]
These 10 sessions focus on parenting issues in a group environment and utilizes video and audio
recordings to help the parents receive feedback on their 30 minute 'special play times' with their
children.
More recently, Aletha Solter has developed a comprehensive approach for parents called
Attachment Play, which describes evidence-based forms of play therapy, including nondirective play,
more directive symbolic play, contingency play, and several laughter-producing activities. Parents
are encouraged to use these playful activities to strengthen their connection with their children,
resolve discipline issues, and also help the children work through traumatic experiences such as
hospitalization or parental divorce.[30]
What is Sandplay Therapy?

Lauren Cunningham

Lauren Cunningham, LCSW, is a founding member of Sandplay Therapists of America and the
founding editor of the Journal of Sandplay Therapy.

Children have always delighted in playing in the sand, bringing their inner and outer worlds together
through imagination. Different cultures have also used sand in imaginal rituals of visioning. The
Dogon medicine men of Mali draw patterns in the sand and later read the paw prints left in the night
by the desert fox to divine the future. Tibetan Buddhist monks spend weeks creating the Kalachakra
sand mandala, which is used for contemplation and initiation into Tantric practices. Donald Sandner,
in Navaho Symbols of Healing, wrote about the Navaho sand painting ceremonies in which images of
world order are created to invoke the healing powers that bring the psyche of the people back into
harmony with the universe. Upon the completion of all these rituals the sand is brushed away and
dispersed.

Whether the makers of these sand creations are children, healers, or priests, potent and ineffable
energies can be stirred on an intuitive, non-rational level. Sand opens the door to the unconscious
world. In western European folklore, the sandman puts children to sleep by sprinkling sand into their
eyes. Sand is impressionable, mutable, and impermanent: "Dancing on sands, and yet no footing
seen," Shakespeare wrote in Venus and Adonis. The sand particles, created by the disintegration of
the earth's rocks, are ideal for pouring and shaping into an image of the symbolic world. We can
"...see a World in a grain of Sand" as Blake wrote in Auguries to Innocence.

So it's not surprising that psychotherapists as contemporary healers stumbled upon playing in the
sand as a therapeutic method. Margaret Lowenfeld, a pioneering child psychoanalyst during the
30's, was the first therapist to put sand into trays with water and figures nearby in her consulting
room. She graciously attributed the invention of what she later called the "World Technique" to the
children themselves who naturally brought these materials together in play therapy.

Dora Kalff was initially influenced by Emma and Carl Jung and her immersion in Tibetan Buddhism.
She also studied with Lowenfeld in London for a year in 1956. When she returned to Zrich Kalff
developed another way of using these materials therapeutically which she called "sandplay."

Sandplay therapists who work in the way Kalff taught differentiate sandplay from sandtray therapy.
Sandtray therapy is a more generic term referring to a variety of effective ways of using sand,
figures, and a container from different theoretical perspectives. Sandplay therapy emphasizes the
spontaneous and dynamic qualities of the creative experience itself. The essence of sandplay is non-
verbal and symbolic. In what Kalff called the "free and protected place" provided by the tray and the
relationship with the therapist, children and adults play with sand, water, and miniatures over a
period of time, constructing concrete manifestations of their inner world. When energies in the form
of "living symbols" are touched upon in the personal and collective unconscious, healing can happen
spontaneously within a person at an unconscious level. As a more harmonious relationship between
the conscious and the unconscious develops, the ego is restructured and strengthened.

Sandplay may open the person to re-experience pre-verbal and non-verbal states. Children
understand (recognize) language before they can speak (recall) language. An adult may have
forgotten or never learned words for some inner experience. Yet they may recognize a figure
intuitively without being able to recall why or what it is. That's why sandplay therapists sometimes
say, "Let the figure pick you!"

The quiet tray with its smooth sand and a trusted therapist nearby allows images to arrive for the
maker. The variety of figures and the sensory experience of sand and water also stimulate the
unconscious. The elemental nature of sandplay evokes the body and touches the mother within.
Sand can be molded, water poured, fire ignited, and air blown. The elemental flow and balance that
is created in the tray mirrors processes in the psyche as well as in the natural world.

The size of the tray itself is meant to hold a person's steady gaze which may encourage a
concentration and intensification of the psyche's energies. The sand and blue bottom and sides offer
the concrete possibility of digging down to the depths or building up to the heights. The three
dimensional figures also offer a fullness of representation that requires no skill. Even a three year old
can build complex, multidimensional scenes. These figures can facilitate both differentiating and
linking together different pieces of meaning and bringing them further into consciousness. Like the
alchemical vessel, the tray within the relationship between the person and the therapist contains
and intensifies the heat and pressure so that a change can happen.

Sandplay's efficacy comes from creating the sand picture itself, as a form of active imagination, not
in focusing on cognitive processing or on the completed production. Sandplay pictures are generally
not interpreted while a process is going on so that the maker can stay close to the living experience
in their body and imagination. The therapist is a witness who primarily reverberates empathically to
the person playing in the sand. When both simultaneously experience the inner world of the
sandplayer through the medium of sandplay a synchronistic moment happens. This helps both to
contain and to honor the experience so that it continues on working in the person. Sandplay is
usually done adjunctively to talk therapy which carries the interpretive aspects of the
psychotherapeutic work. Review and more analytic discussion of the trays themselves can happen
years after the process is completed. The heart of becoming a sandplay therapist is in the
experiencing of a personal sandplay process with its cycles of getting lost, waiting, and coming
home. It is a deeply held Jungian principle that the therapist as wounded healer has to have been
initiated themselves before becoming a guide for others.

Although the use of sand in ritual practices exists on a continuum from ancient traditions through
Jungian and other psychotherapeutic methods, sandplay therapists are now concerned about the
economics of healthcare and the impact of modern day values on the future of sandplay. Sandplay
therapists also need to continue to relate their work to ongoing developments in understanding the
psyche. In the midst of the thrust and rush towards the future, the simplicity and depth of sandplay
may help it maintain its integrity as a place of sanctuary and healing.


Reference:
Sandner, Donald (1991). Navaho Symbols of Healing. Rochester: Healing Arts Press.

Journal of Sandplay Therapy, Volume 6, Number 1, 1977.